Effects of early intensive and moderate insulin therapy on the prognosis of patients with severe acute pancreatitis
10.3760/cma.j.issn.1673-9752.2012.04.009
- VernacularTitle:早期强化与适度胰岛素治疗对重症急性胰腺炎患者预后的影响
- Author:
Zuoyi JIAO
;
Yi SHANG
;
Changjiang LUO
;
Zeyuan YU
;
Huinian ZHOU
;
Bin ZHAO
;
Yumin LI
- Publication Type:Journal Article
- Keywords:
Severe acute pancreatitis;
Prognosis;
Insulin
- From:Chinese Journal of Digestive Surgery
2012;11(4):327-330
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the efficacies of early intensive and moderate insulin therapy on the prognosis of patients with severe acute pancreatitis (SAP).Methods The clinical data of 78 patients with SAP complicated by hyperglycemia who were admitted to the Second Hospital of Lanzhou University from January 2005 to December 2009 were retrospectively analyzed.All patients were divided into the intensive insulin therapy (IIT)group (31 patients) and moderate insulin therapy (MIT) group (47 patients).The target levels of blood glucose were 0.80-1.10 g/L(4.4-6.1 mmol/L) in the IIT group and 1.44-1.80 g/L(8.0-10.0 mmol/L) in the MIT group,respectively.The effects of the 2 therapies on the prognosis of the patients were compared.All data were analyzed by the t test or chi-square test.Results The daily intravenous insulin dosage,fasting glucose level and incidence of severe hypoglycemia were ( 35 ± 11 ) u,( 1.02 ± 0.13 ) g/L[ (5.7 ± 0.7 ) mmol/L] and 10％ (3/31 )in the IIT group,and ( 24 ± 15 ) u,( 1.58 ± 0.21 ) g/L[ ( 8.8 ± 1.2 ) mmol/L] and 2％ ( 1/47 ) in the MIT group.A significant difference was detected in the daily intravenous insulin dosage between the 2 groups( t =12.76,P ＜=0.05),but no significant difference was detected in the incidence of severe hypoglycemia between the 2 groups (x2 =0.91,P ＞ 0.05 ).The levels of albumin and prealbumin on the 14th day were ( 34 ± 6) g/L and (231 ± 31 ) mg/L in the IIT group,and (35 ± 5)g/L and (241 ± 29)mg/L in the MIT group,respectively,with no significant difference between the 2 groups( t =-1.94,-1.68,P ＞ 0.05).The incidences of abdominal infection,circulatory dysfunction,respiratory dysfunction and acquired kidney injury were 23％ (7/31),32％ (10/31),26％ (8/31)and 13％ (4/31) in the lIT group,and 26％ (12/47),36％ ( 17/47),30％ (14/47) and 23％ (11/47) in the MIT group,with no significant difference between the 2 groups(x2 =0.09,0.13,0.15,1.33,P ＞ 0.05).The scores of APPACHE Ⅱ on the 14th day were 9 ± 4 in the IIT group and 9 ± 3 in the MIT group,respectively,with no significant difference between the 2 groups ( t =- 0.60,P ＞ 0.05 ).There were 4 ( 13％ ) patients in the IIT group and 7( 15％ ) patients in the MIT group died of multi-organ dysfunction syndrome,including 2 patients in the IIT group and 6 patients in the MIT group complicated with sepsis.There was no significant difference in the mortality between the 2 groups ( x2 =0,P ＞ 0.05 ).Conclusions Compared with MIT,early IIT could not improve the prognosis of the patients with SAP.MIT is appropriate for SAP patients complicated with hyperglycemia.
